Nepal Journal of Neuroscience
Official Journal of Nepalese Society of Neurosurgeons

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Managing Epilepsy II: Surgical Treatment of Epilepsy in Children.

Rodger J. Hudgins, MD, C. Lynn, RN
Chief of Pediatric Neurosurgery Children's Healthcare of Altanta Atlanta, Georgia USA C. Lynn Gilreath, RN Children's Healthcare of Altanta Atlanta, Georgia USA

10-20% of all epilepsy is intractable, that is, poorly controlled despite treatment with antiepileptic medications to therapeutic levels both singly and in combinations. Most intractable epilepsy begins during childhood. It has long been established that poorly controlled seizures have an adverse effect on cognitive and psychosocial development. In many cases when medications are not effective, surgery is a viable option. The preoperative evaluation involves video-EEG monitoring, high-resolution MRI, and detailed neuropsychological testing. Resection surgery is performed when the area of seizure onset is focal. Disconnection surgery such as corpus callosotomy is used if the seizures are generalized. Vagal nerve stimulation (VNS) is the procedure of choice if the area of seizure onset can not be localized or in many types of generalized seizures. Children have favorable outcomes from epilepsy surgery similar to those in adults.

Key Words: epilepsy surgery, focal cortical dysplasia, hemispherectomy, pediatrics, vagal nerve stimulation